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The article presents a case study of a 53-year-old woman with paresthesia and pain in her right thumb and right index finger, who was referred for electrodiagnostic test of carpal tunnel syndrome (CTS). Allodynia, hyperesthesia,and hypoalgesia in the right thumb and on the lateral side of the right index finger were detected in a physical examination. The injection of methylprednisolone acetate into the median nerve of the patient improved her symptoms.

Abstract: This study examined the relationship between microglia activation in the cuneate nucleus (CN) and behavioral hypersensitivity after chronic constriction injury (CCI) of the median nerve. We also investigated effects of local lidocaine pre- and post-treatment on microglia activation and development of hypersensitivity in this model. By immunohistochemistry and immunoblotting, little immunoreactivity of OX-42, a microglia activation marker, was detected in the CN of normal rats. As early as 1day after CCI, there was a significant increase in OX-42 immunoreactivity in the lesion side of CN, which reached a maximum at 14days. Microinjection of minocycline, a microglia activation inhibitor, into the CN 1day after CCI attenuated injury-induced behavioral hypersensitivity in a dose-dependent manner. Furthermore, the animals received 1%, 2% or 5% lidocaine 15min prior to median nerve CCI (pre-treatment), 5h (early post-treatment) or 1day (late post-treatment) after median nerve CCI. Pre-treatment and early post-treatment with 2% and 5% lidocaine, but not 1% lidocaine, attenuated OX-42 immunoreactivity and behavioral hypersensitivity following median nerve injury. Late post-treatment with 1%, 2%, or 5% lidocaine failed to decrease OX-42 immunoreactivity and mechanical hypersensitivity in CCI rats. In conclusion, median nerve injury-induced microglia activation in the CN modulated development of behavioral hypersensitivity. High-concentration lidocaine was effective in decreasing microglia activation in the CN and in attenuating neuropathic pain sensations at the early stage following nerve injury, when microglia had not yet been activated. [Copyright &y& Elsevier]

Background: Ultrasound has recently emerged as a diagnostic tool in carpal tunnel syndrome (CTS). Purpose: To evaluate the utility of a combination of high-resolution and color Doppler ultrasound as an alternative to electrodiagnostic tests (EDT), in CTS diagnosis, and to define an ultrasonographic prediction model for CTS. Material and Methods: A total of 85 patients with certain clinical diagnosis of CTS and 49 healthy controls were enrolled. High-resolution and color Doppler ultrasound were performed and the cross-sectional area (CSA), hypoechogenicity, and hypervascularity of the median nerve were evaluated. Receiver-operating characteristic curves were used to determine the optimal cut-off point of median nerve CSA in diagnosis of CTS. Multivariate logistic regression analysis was used to formulate a prediction model for CTS. Results: The optimal cut-off point of median CSA in wrist was 10.5 mm(2). Hypervascularity (OR = 37.95), hypoechogenicity (OR = 12.30), and high CSA (OR = 34.79) of median nerve were significantly (P < 0.001) higher in CTS patients than in controls. No significant difference was found between the sensitivity and specificity of EDT and any of the above indices in prediction of CTS. An ultrasonographic model for prediction of CTS, comprised hypervascularity and/or high CSA of median nerve, could predict the CTS probability between 87-99%. The sensitivity and specificity of this model (86% and 84%) was not different from EDT (80% and 84%). Conclusion: A combination of high-resolution and color Doppler ultrasound can be used as a non-invasive alternative to EDT in diagnosis of CTS. [ABSTRACT FROM AUTHOR]

Purpose: Dentists and dental hygienists have been reported as having a high prevalence of upper-extremity musculoskeletal disorders, including carpal tunnel syndrome. Unfortunately, previous research has not involved the impact of preventive dental specialist training on dental assistants. Therefore, the purpose of this study was to determine the presence of median and ulnar neuropathies in US Army dental assistants before and after training as preventive dental specialists. Methods: Thirty-five US Army dental assistants (24 female, 11 male; age range 18-41 years) volunteered for the study. Twenty-eight preventive dental specialist students completed both the pretraining and posttraining data collections. Subjects were evaluated during the first and last weeks of their 12-week course. Subjects completed a history form, were interviewed, and underwent a physical examination. Nerve conduction status of the median and ulnar nerves of both upper extremities were obtained by performing motor, sensory, comparison (unilateral median to ulnar distal motor and sensory latencies), and F-wave nerve conduction studies (NCS). Descriptive statistics for subject demographics and pre to post physical examination and nerve conduction variables were calculated. Chi square (X2) analysis was also conducted to determine if a significant shift in the prevalence of neuropathies occurred following dental training. Results: With the exception of comparison studies, pre-NCS and post-NCS electrophysiological variables were normal. Specifically, 9 subjects (26%) involving 14 hands (20%) were found to have meaningful (>1.0 millisecond) delayed median to ulnar distal motor latency comparisons in the pretraining assessment. Additionally, there was no statistically significant shift in the prevalence of electrodiagnostic abnormalities of the median nerve following the 12-week training program (X2=0.280, P=.60). Conclusion: The prevalence of clinical and electrodiagnostic abnormalities of the median nerve in this sample of US Army dental assistants closely mirrors the prevalence reported for other dental professionals. This study also demonstrates that, for this sample, the 12-week training program did not appear to affect the electrophysiologic status of the median or ulnar nerves. [ABSTRACT FROM AUTHOR]

The article focuses on a study conducted to access the responsiveness of sensibility and strength tests in patients undergoing carpal tunnel decompression using standardized clinician-derived follow up. The study found that touch threshold assessed by monofilaments (WEST) and tactile diagnosis measured with the shape-texture identification (STI) test are the most responsive tests for clinical assessment of sensibility.

Purpose: To establish the rate of iatrogenic injury after endoscopic carpal tunnel release (ECTR) for a surgeon in the first 2 years of practice; to report the rate of conversion from ECTR to open carpal tunnel release (OCTR), the reason for conversion, and any increase in morbidity found in patients converted to OCTR; and to determine whether the conversion rate decreased with increasing surgeon experience. Methods: We conducted a retrospective review of patients undergoing ECTR by a single surgeon in the first 2 years of practice. Data collected or calculated included symptom relief, rate of conversion to OCTR, reason for conversion, and neurovascular complications. For patients converted to OCTR, we assessed satisfaction and function using the Disabilities of the Arm, Shoulder, and Hand questionnaire. We compared these results for 1 to 6 months, 7 to 12 months, and 12 to 24 months to determine whether a learning curve was present. Results: A total of 278 patients (358 procedures) underwent ECTR. Of these, 12 patients required conversion to OCTR during the index procedure over a 2-year period. In the first 6 months of practice, 8 of 71 ECTRs were converted to OCTR compared to 1 of 72 in the second 6 months. This was a statistically significant decrease (p = .017). In year 2, 3 of 215 patients were converted to OCTR. Average Disabilities of the Arm, Shoulder, and Hand score for patients converted from ECTR to OCTR was 9. No patients required repeat surgery for recurrence of carpal tunnel symptoms. We observed no major neurovascular complications. Conclusions: A learning curve for ECTR was present. Rates of conversion significantly diminished with increased surgeon and anesthesia experience. Patients requiring conversion showed no variation in Disabilities of the Arm, Shoulder, and Hand scores from established values after OCTR. Patients may be at a higher risk of conversion to OCTR during the learning curve time period; nevertheless, we found no increased morbidity. Type of study/level of evidence: Prognostic III. [Copyright &y& Elsevier]

Background : Although there remain concerns of median nerve damage during endoscopic carpal tunnel release for carpal tunnel syndrome, carpal tunnel pressure variations during Chow's two-portal technique have not been well investigated. Methods : We performed a modified two-portal endoscopic carpal tunnel release on 30 patients by inserting a catheter pressure transducer into the carpal tunnel for continuous pressure measurement during the procedure. Grip and pinch strengths, Semmes–Weinstein monofilament test, and nerve conduction studies were examined preoperatively and at postoperative 1, 3, and 6months. Numbness and the Disabilities of the Arm, Shoulder and Hand score were also evaluated pre and postoperatively. Findings : Subjective symptoms and nerve conduction study findings improved uneventfully. The pressure was always observed to be maximum pressure immediately before the cannula was withdrawn from the exit portal, and carpal tunnel pressure >300mmHg was recorded in most of the patients. Interpretation : A transient increase in the carpal tunnel pressure occurred in all the patients; however, it did not correlate with their clinical outcome or with increased risk of peri-operative complications. Since time–pressure threshold of the median nerve during endoscopic carpal tunnel release is still unknown, our results did not guarantee its safety. [Copyright &y& Elsevier]

Abstract: Background: Penile rehabilitation (PR) is widely applied after radical prostatectomy. Vacuum erectile device (VED) therapy is the one of three PR methods used in the clinical setting that improve erectile function (EF) and is the only PR method which may preserve penile length. However, its unknown mechanism hampered doctors’ recommendations and patients’ compliance. Objectives: To assess the effects of VED therapy on erectile dysfunction (ED) in a rat model of bilateral cavernous nerve crush (BCNC) and to investigate the molecular mechanism of VED in postprostatectomy ED. Design, setting, and participants: This was an experimental study using Sprague-Dawley rats in three groups: sham, BCNC, and BCNC plus VED. Intervention: Intervention included BCNC, electrical stimulation of the cavernous nerve (CNS), and VED therapy. Measurements: At the end of a 4-wk period, CNS was used to assess EF by maximum intracavernosal pressure (ICP)/mean arterial pressure (MAP) ratio and duration (area under the curve [AUC]). For the structural analyses, whole rat penis was harvested. Terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling assay was used for the assessment of apoptotic indices (AI). Immunohistochemistry was performed for endothelial nitric oxide synthase (eNOS), α-smooth muscle actin (ASMA), transforming growth factor beta 1 (TGF-β1), and hypoxia inducible factor-1α (HIF-1α). Staining for Masson''s trichrome was utilized to calculate the smooth muscle/collagen ratios. Results and limitations: EF was improved with VED therapy measured by ICP/MAP ratios and AUC. VED therapy reduced HIF-1α expression and AI significantly compared with control. Animals exposed to VED therapy had decreased TGF-β1 expression, increased smooth muscle/collagen ratios, and preserved ASMA and eNOS expression. Conclusions: To our knowledge, this is the first scientific study to suggest that VED therapy in the BCNC rat model preserves EF through antihypoxic, antiapoptotic, and antifibrotic mechanisms. [Copyright &y& Elsevier]

Variant brachial plexus formation with two trunks and two cords is uncommon and has clinical implications as it may result in failure of regional brachial or axillary block. During routine anatomical dissection, unilateral variation in the formation of brachial plexus accompanied by unusual positional relationship with axillary artery was discovered in the left upper extremity of a 52-year-old Indian male cadaver. Brachial plexus showed two trunks formed by ventral rami of C5, C6 and C7, C8, T1 spinal nerves, respectively, which first split and then reunited in an unusual manner to form two cords: posterior and lateral instead of three. Medial cord was absent. The branching pattern of the brachial plexus also showed important variations. Second part of axillary artery was found lying inferomedial to brachial plexus instead of passing between medial and lateral cords. Transverse cervical artery was found to be coursing between two trunks instead of passing superficial to brachial plexus. Median nerve was observed to be formed from a single root, instead of usual two roots. Embryologically, this rare variation may be due to the development of axillary artery from ninth segmental artery instead of usual seventh cervical intersegmental artery. Such rare variation is clinically important as this knowledge may help the anesthesiologists and the surgeons to avoid any inadvertent damage to nerves and axillary artery during blocks and surgical interventions. [ABSTRACT FROM AUTHOR]

Diagnostic tests in patients complaining of carpal tunnel syndrome (CTS) are based on physical examination, electrodiagnostic tests (EDTs), and diagnostic imaging. Timely diagnosis helps prevent permanent nerve damage and its sequelae in terms of functional impairment. Imaging provides additional information to that obtained from clinical tests and EDTs. By allowing direct visualization of the compressed median nerve (MN), ultrasound (US) and magnetic resonance imaging can depict the causes for secondary CTS and describe anatomical variants, such as a bifid MN or a persistent median artery of the forearm, as well as space-occupying lesions including tenosynovitis and ganglion cysts. In addition, diagnostic imaging is of value for postoperative patients presenting with persistent symptoms. Finally, US is able to add information for EDT- negative symptomatic patients. Over time, US has increased in its sensitivity and specificity so it can be used as the initial test in patients presenting with clinical symptoms of CTS because it is now equivalent to EDT. The use of US as a screening test may reduce the number of EDT examinations in patients with suspected CTS, providing additional valuable anatomical information. [ABSTRACT FROM AUTHOR]

The aim of the current study was to identify whether hyperexcitability of the central nervous system is a prognostic factor for individuals with carpal tunnel syndrome (CTS) likely to experience rapid and clinical self-reported improvement following a physical therapy program including soft tissue mobilization and nerve slider neurodynamic interventions. Women presenting with clinical and electrophysiological findings of CTS were involved in a prospective single-arm trial. Participants underwent a standardized examination and then a physical therapy session. The physical therapy sessions included both soft tissue mobilization directed at the anatomical sites of potential median nerve entrapment and a passive nerve slider neurodynamic technique targeted to the median nerve. Pressure pain thresholds (PPT) over the median, radial and ulnar nerves, C5-C6 zygapophyseal joint, carpal tunnel and tibialis anterior muscle were assessed bilaterally. Additionally, thermal detection and pain thresholds were measured over the carpal tunnel and thenar eminence bilaterally to evaluate central nervous system excitability. Subjects were classified as responders (having achieved a successful outcome) or non-responders based on self-perceived recovery. Variables were entered into a stepwise logistic regression model to determine the most accurate variables for determining prognosis. Data from 72 women were included in the analysis, of which 35 experienced a successful outcome (48.6%). Three variables including PPT over the C5-C6 joint affected side <137 kPa, HPT carpal tunnel affected side <39.6º and general health >66 points were identified. If 2 out of 3 variables were present (LR + 14.8), the likelihood of success increased from 48.6 to 93.3%. We identified 3 factors that may be associated with a rapid clinical response to both soft tissue mobilization and nerve slider neurodynamic techniques targeted to the median nerve in women presenting with CTS. Our results support that widespread central sensitization may not be present in women with CTS who are likely to achieve a successful outcome with physical therapy. Future studies are now necessary to validate these findings. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the reduction of pain score, in patients with carpal tunnel syndrome after treatment with microamps TENS. STUDY DESIGN: Quasi experimental. PLACE AND DURATION OF STUDY: Neurology Department Dow University Of Health Sciences Civil Hospital Karachi, from 27th February 2008 to 27th August 2008 METHODOLOGY: Patients were evaluated between February 2008 and August 2008. Pre treatment pain score was assessed by the author with the help of a linear pain scale numbering 0-5. All patients received 4 weeks TENS therapy, (3 times a week, 45 minute of each session). Re-evaluation of pain score was done within one week of completion of treatment. Paired't' test was applied to compare mean significant difference between pre and post treatment pain score. Chi-square test was also applied to compare difference of post treatment pain score for gender and duration of symptoms. P ? 0.05 was considered level of significant. RESULTS: Out of 51 CTS patients 37(72.5%) were female and 14(27.5%) were male. Mean ± SD difference in pre and post treatment pain score was 3.41±1.04 with 95% confidence interval 3.12 to 3.71 (t = 23.4; df = 50; p value 0.00).Duration of symptoms was statistically significant in reduction of post treatment pain score (Chi-Square= 12.07; df =3; P=0.007) while gender difference was not statistically significant. (Chi- Square= 3.96; df =3; P=0.265). CONCLUSION: After treatment with transcutaneous electrical nerve stimulation pain was significantly reduced. Lesser the duration of symptoms better the outcome while gender difference was not proved to be statistically significant. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome is a commonly encountered entrapment disorder resulting from mechanical insult to the median nerve. Magnetic resonance imaging (MRI)-based investigations have documented typical locations of the median nerve within the carpal tunnel; however, it is unclear whether those locations are consistent within an individual on different days. Methods: To determine the day-to-day variability of nerve location, 3.0T MRI scans were acquired from six normal volunteers over multiple sessions on three different days. Half of the scans were acquired with the wrist in neutral flexion and the fingers extended, and the other half were acquired with the wrist in 35° of flexion and the fingers flexed. Prior to half of the scans (in both poses), subjects performed a preconditioning routine consisting of specified hand activities and several repetitions of wrist flexion/extension. The shape, orientation, location, and location radius of variability of the median nerve and three selected flexor tendons were determined for each subject and compared between days. Findings: Two of the six subjects had substantial variability in nerve location when the wrist was in neutral, and four of the subjects had high variability in nerve position when the wrist was flexed. Nerve variability was typically larger than tendon variability. The preconditioning routine did not decrease nerve or tendon location variability in either the neutral or the flexed wrist positions. Interpretation: The high mobility and potential for large variability in median nerve location within the carpal tunnel needs to be borne in mind when interpreting MR images of nerve location. [Copyright &y& Elsevier]

Thenar muscle atrophy is a common finding in long-standing severe carpal tunnel syndrome (CTS). Combination of carpal tunnel release and Camitz opponensplasty has been used to treat severe CTS with thenar muscle atrophy. Camitz opponensplasty is beneficial for abduction, but provides little benefit to thumb flexion and pronation. This problem could be overcome by the use of a pulley. Twelve cases of long-standing CTS with severe thenar muscle atrophy in 11 patients were investigated. They were treated with the modified Camitz opponensplasty using a pulley at the ulnar side remnant of the flexor retinaculum at the time of carpal tunnel release. Outcome was assessed by clinical grade of thenar muscle atrophy, degree of thumb opposition and the patient’s satisfaction. The average grade of thenar muscle atrophy improved from grade 3 pre-operatively to grade 0.83 at the last follow-up. Mean maximal palmar abduction improved from 3.6 to 6.8 cm, and spatial rotation improved from 54° to 83°. Kapandji tip opposition changed from 65 to 85% symmetry at the last follow-up. All 11 patients were ‘very satisfied’ or ‘satisfied’ with the outcome. Modified Camitz opponensplasty is a simple procedure that provides immediate improvement of thenar function. Palmar flexion and pronation can be further improved by addition of a pulley. [ABSTRACT FROM AUTHOR]

Diabet. Med. 27, 466–472 (2010) Aims To determine health-related quality of life (HRQL) in diabetic and non-diabetic patients with carpal tunnel syndrome (CTS) before and after surgical treatment. Methods In a prospective study, 35 consecutive diabetic patients with CTS were age and gender matched with 31 non-diabetic patients with idiopathic CTS. At baseline (preoperatively), 6, 12 and 52 weeks after surgical carpal tunnel release, patients completed the generic Short-Form 36 (SF-36) and the disease-specific Boston Carpal Tunnel Questionnaire (BCTQ). Results The SF-36 physical component scores at baseline were significantly reduced for diabetic (39 ± 7.4) compared with non-diabetic patients (48 ± 9.0) ( P < 0.05). Mixed model analysis demonstrated no differences in post-surgical improvement over time between diabetic and non-diabetic patients. The largest clinical effect was found for bodily pain (effect size 0.8). However, population norms were not reached for the diabetic patients. At baseline, no difference was found in mental component score, which deteriorated over time for diabetic patients. At baseline, BCTQ demonstrated that diabetic patients experienced more pronounced ‘numbness in the hand’ than non-diabetic patients. Large clinical improvements were found in both symptom severity (effect size 1.98–2.14) and functional status score (effect size 0.89–0.94) for both diabetic and non-diabetic patients, with no difference between the two patient groups. Conclusions HRQL is impaired in diabetic patients with CTS compared with non-diabetic patients with CTS and population norms. However, diabetic patients experience similar symptomatic and functional benefits from carpal tunnel release as do non-diabetic patients. [ABSTRACT FROM AUTHOR]

Abstract: Extraterritorial spread of sensory symptoms is frequent in carpal tunnel syndrome (CTS). Animal models suggest that this phenomenon may depend on central sensitization. We sought to obtain psychophysical evidence of sensitization in CTS with extraterritorial symptoms spread. We recruited 100 unilateral CTS patients. After selection to rule out concomitant upper-limb causes of pain, 48 patients were included. The hand symptoms distribution was graded with a diagram into median and extramedian pattern. Patients were asked on proximal pain. Quantitative sensory testing (QST) was performed in the territory of injured median nerve and in extramedian territories to document signs of sensitization (hyperalgesia, allodynia, wind-up). Extramedian pattern and proximal pain were found in 33.3% and 37.5% of patients, respectively. The QST profile associated with extramedian pattern includes: (1) thermal and mechanic hyperalgesia in the territory of the injured median nerve and in those of the uninjured ulnar and radial nerves and (2) enhanced wind-up. No signs of sensitization were found in patients with the median distribution and those with proximal symptoms. Different mechanisms may underlie hand extramedian and proximal spread of symptoms, respectively. Extramedian spread of symptoms in the hand may be secondary to spinal sensitization but peripheral and supraspinal mechanisms may contribute. Proximal spread may represent referred pain. Central sensitization may be secondary to abnormal activity in the median nerve afferents or the consequence of a predisposing trait. Our data may explain the persistence of sensory symptoms after median nerve surgical release and the presence of non-anatomical sensory patterns in neuropathic pain. [Copyright &y& Elsevier]

Background: Patients with idiopathic carpal tunnel syndrome (CTS) are commonly treated with steroid injection into or proximal to the carpal tunnel. However, evidence for its efficacy beyond one month has not been established in randomized placebo-controlled trials. The primary aim of this randomized trial is to assess the efficacy of steroid injection into the carpal tunnel in relieving symptoms of CTS in patients with symptoms of such severity to warrant surgical treatment but have not been treated with steroid injection. Methods/Design: The study is a randomized double-blind placebo-controlled trial. Patients referred to one orthopedic department because of CTS are screened. Eligibility criteria are age 18 to 70 years, clinical diagnosis of primary idiopathic CTS and abnormal nerve conduction tests or clinical diagnosis made independently by two orthopedic surgeons, failed treatment with wrist splinting, symptom severity of such magnitude that the patient is willing to undergo surgery, no severe sensory loss or thenar muscle atrophy, and no previous steroid injection for CTS. A total of 120 patients will be randomized to injection of 80 mg Methylprednisolone, 40 mg Methylprednisolone, or normal saline, each also containing 10 mg Lidocaine. Evaluation at baseline and at 5, 10, 24 and 52 weeks after injection includes validated questionnaires (CTS symptom severity scale, QuickDASH and SF-6D), adverse events, physical examination by a blinded assessor, and nerve conduction tests. The primary outcome measures are change in the CTS symptom severity score at 10 weeks and the rate of surgery at 52 weeks. The secondary outcome measures are the score change in the CTS symptom severity scale at 52 weeks, time to surgery, and change in QuickDASH and SF-6D scores and patient satisfaction at 10 and 52 weeks. The primary analysis will be carried out using mixed model analysis of repeated measures. Discussion: This paper describes the rationale and design of a double-blind, randomized placebo-controlled trial that aims to determine the efficacy of two different doses of steroid injected into the carpal tunnel in patients with moderately severe idiopathic CTS. Trial registration: Clinicaltrials.gov identifier NCT00806871 [ABSTRACT FROM AUTHOR]

Abstract: In this study, we examined the relationship between astrocyte activation in the cuneate nucleus (CN) and behavioral hypersensitivity after chronic constriction injury (CCI) of the median nerve. In addition, we also examined the effects of pre-emptive treatment with a number of drugs on astrocyte activation and hypersensitivity development in this model. Using immunohistochemistry and immunoblotting, little glial fibrillary acidic protein (GFAP; an astrocyte marker) immunoreactivity was detected in the CN of the normal rats. As early as 3days after CCI, there was a significant increase in GFAP immunoreactivity in the lesion side of CN, and this reached a maximum at 7days, and was followed by a decline. Counting of GFAP-immunoreactive astrocytes revealed that astrocytic hypertrophy, but not proliferation, contributes to increased GFAP immunoreactivity. Furthermore, microinjection of the glial activation inhibitor, fluorocitrate, into the CN at 3days after CCI attenuated injury-induced behavioral hypersensitivity in a dose-dependent manner. These results suggest that median nerve injury-induced astrocytic activation in the CN modulated the development of behavioral hypersensitivity. Animals received MK-801 (glutamate N-methyl-d-aspartate (NMDA) receptor antagonist), clonidine (α2-adrenoreceptor agonist), tetrodotoxin (TTX, sodium channel blocker) or lidocaine (local anesthetic) 30min prior to median nerve CCI. Pre-treatment with MK-801, TTX, and 2% lidocaine, but not clonidine, attenuated GFAP immunoreactivity and behavioral hypersensitivity following median nerve injury. In conclusion, suppressing reactions to injury, such as the generation of ectopic discharges and activation of NMDA receptors, can decrease astrocyte activation in the CN and attenuate neuropathic pain sensations. [Copyright &y& Elsevier]

Fibrolipomatous hamartoma of the median nerve are usually located distally in the forearm and may have characteristic features on MR imaging. Here we report a patient with an extensive fibrolipomatous hamartoma at an unusual location proximally in the arm, where a preoperative MR imaging was pathognomonic and diagnosis was verified by an incisional biopsy. We suggest that MRI should be performed in cases with nerve dysfunction without an obvious cause after a thorough clinical examination. [ABSTRACT FROM AUTHOR]

The article presents a case study of a patient with multiple abscesses of the median nerve as a manifestation of lepra reaction while suffering from leprosy. Topics discussed include the patient's diagnosis of leprous mononeuritis multiplex treated with multidrug therapeutic regimen, the findings from the Slit-skin smear test such as Mycobacterium leprae baciili and nerve abscesses in patients with paucibacillary leprosy.

We have previously discussed compression neuropathies of the radial nerve in the forearm. In the second half of this 2-part review, we will now turn our attention to 2 compression neuropathies affecting the proximal median nerve, before its entry through the carpal tunnel: (1) pronator syndrome and (2) anterior interosseous nerve syndrome. [Copyright &y& Elsevier]

One hundred and fifty-two patients with suspected carpal tunnel syndrome (CTS) completed a questionnaire, including questions about the location of paraesthesia, nocturnal pain, the effect of shaking the hand, relief by use of a wrist splint and impairment of manual dexterity. A score was derived from the symptom questionnaire and clinical signs including Tinel’s test, Phalen’s test, and altered sensation. Nerve conduction studies (NCS) were done in 91 cases in which the diagnosis of CTS was in doubt. A threshold questionnaire score was selected as indicating a diagnosis of CTS. Sixty-six patients were predicted to have CTS. When compared with the results of NCS this score had a specificity of 67% and sensitivity of 82%. Ninety-five patients underwent carpal tunnel release. A management model has been developed based on the questionnaire score for symptoms and signs. [ABSTRACT FROM PUBLISHER]

This study was conducted to assess the use of a modified carpal tunnel syndrome questionnaire (the Boston Carpal Tunnel Questionnaire, BCTQ) in an Indian patient population. Seventy-six Indian patients with carpal tunnel syndrome (CTS) were recruited to this prospective study. On a scale of one to five, the average score for the severity of symptoms was 2.09 (0.89). The average score for functional disability was 1.94 (0.74), which was lower than the average function score reported for Western CTS patients (Levine et al., 1993). The symptom severity and function disability scores were higher in patients with positive Tinel’s sign and Phalen’s test. The function disability score was moderately correlated with other clinical tests for CTS. The average modified BCTQ scores for Indian CTS patients was established through this study. This modified questionnaire might assist physicians in developing countries to assess disability from CTS, although socioeconomic and cultural differences will have to be taken into account when comparing assessments across different populations. [ABSTRACT FROM PUBLISHER]

The article presents a study which compared surgical and multi-modality, non-surgical treatment for patients with carpal tunnel syndrome without denervation. Carpal tunnel syndrome is cited as a major cause of work disability and can be treated through non-surgical and surgical approaches. The study found that surgery improves symptoms of patients with carpal tunnel syndrome without denervation more than does a non-surgical treatment. Patients assigned to surgery were found to have greater relief of symptoms and improvement in hand function than patients assigned to non-surgical treatment.

Background: Factors regarding patient willingness to undergo or avoid joint replacement have been studied; however, these factors have not been studied in patients with carpal tunnel syndrome. To further understand the aspects that are important for a patient with carpal tunnel syndrome in deciding whether to have surgery, we identified factors that affect this decision in women and that are not related to Workers' Compensation status. Methods: We retrospectively reviewed 282 female patients with electrophysiologically confirmed carpal tunnel syndrome without a known cause who were recommended for carpal tunnel release by a single hand surgeon in a tertiary medical setting. Of those, thirty-six female patients who were not entitled to Workers' Compensation canceled the operation during the waiting period, which averaged four weeks. Thirty-three of them were surveyed with a questionnaire sent by mail, and eighteen completed surveys were reviewed at a mean follow-up of thirty-two months. Furthermore, seventy female patients who underwent carpal tunnel release were randomly sampled, and thirty-eight patients completed the survey. The operation and cancellation groups were compared with regard to the reasons for choosing or canceling surgery. Results: The groups were similar with regard to age, sociodemographic variables, follow-up length, initial electrophysiological findings, and functional status. The highest-ranked reason for choosing surgery was symptom severity rather than fear of progression or a positive electrodiagnostic result. Those who canceled the operation rated symptom improvement during the waiting period as the leading reason for doing so, but they were also concerned about transient weakness, the financial burden, and a scar or pillar pain. Disease persistence or recurrence was the issue of most concern in both groups. At the time of the final review, the functional status was significantly improved in both groups and no significant difference between the groups was detected. Conclusions: Women with carpal tunnel syndrome report that subjective symptom severity is the most important reason for undergoing surgery. Understanding this and other patient concerns may help physicians during patient-oriented consultation and decision-making. In particular, recommendations for carpal tunnel release on the basis of symptoms are reasonable from the perspective of the patient who has carpal tunnel syndrome without a known cause. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate morphological changes of the median nerve in patients with carpal tunnel syndrome (CTS) and healthy controls, to correlate the MRI findings of wrists. This study compared not only morphological changes of the median nerve and also displayed descriptively structures in carpal tunnel between patients diagnosed with idopathic CTS and healthy controls. Our study involved 60 hand, 30 of hand were evaluated diagnosed with idiopathic CTS and 30 hand as healthy controls bilaterally. Two provocative tests (Phalen's and Tinel's test) were performed on each hand for both the patient group (60 wrist) and the control group (60 wrist). With regard to Phalen and Tinel's test results, 24 and 26 wrists were excluded from patient and control groups respectively. Totally 70 wrists were evaluated, and in terms of cross-sectional area of median nerve at the level of distal radioulnar joint, pisiform bone and the hook of hamate bone by MRI in the patient and control groups. In addition to evaluation of crosssectional area of median nerve, we determined signal intensity of wrists and different localization of the median nerve in the carpal tunnel. Cross-sectional area of the median nerve measured by wrist magnetic resonance at the level of metacarpal bones and signal intensity of wrists may be considered as a valuable indicator to determine patients referred with idiopathic CTS. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 42-year-old woman who felt numbness over her left fingers and hand after a self-inflicted cutting of the wrist and subsequent tendon and median nerve repair. It notes that the result of her electrodiagnostic testing was normal but the high-resolution ultrasound showed focal swelling in median nerve region that is consistent with a neuroma. It mentions that the patient underwent nerve repair with a nerve graft after neuroma excision during surgery.

AbstractThis study sought to investigate the effects of injury-induced neuropeptide Y (NPY) on c-Fos expression in the cuneate neurons and neuropathic pain after median nerve injury. Four weeks after median nerve transection (MNT), the injured nerves stimulated at low intensity (0.1 mA) expressed significantly less NPY-like immunoreactive (NPY-LI) fibers in the cuneate nucleus (CN) than those stimulated at high intensities (1.0 mA and 10 mA). Conversely, a significantly higher number of c-Fos-LI cells were observed in the CN in rats stimulated with 0.1 mA compared to those stimulated with 1.0 mA or 10 mA. These results suggest that more NPY was released following low-intensity stimulation, and consequently fewer NPY-LI fibers and more c-Fos-LI cells were identified in the CN. Furthermore, the number of c-Fos-LI cells as well as the percentage of c-Fos-LI cuneothalamic projection neurons (CTNs) in the CN was markedly decreased after injection of NPY receptor antagonist along with retrograde tract-tracing method, indicating that NPY regulated c-Fos expression. In rats with median nerve chronic constriction injury (CCI), intracerebroventricular injection of NPY aggravated mechanical allodynia and low-intensity stimulus-evoked c-Fos expression, both of which were reversed by injection of NPY receptor antagonist. However, thermal hyperalgesia was not affected by injection of these two reagents. Taken together, these findings suggest that more NPY release, following low-intensity electrical stimulation of the injured nerve, significantly induces c-Fos expression in the CTNs, which possibly provide the ascending thalamic transmission of neuropathic pain signals. [ABSTRACT FROM AUTHOR]

A prospective study was performed to assess the outcome of conservative treatment of carpal tunnel syndrome and to establish the predictive value of preoperative Boston carpal tunnel questionnaire scores. Sixty-seven patients with 101 symptomatic hands underwent an evidence-based education and conservative therapy regime prior to surgery. All patients were scored using the Boston carpal tunnel questionnaire at presentation and at 3 months. Fifty-eight of 67 patients completed both assessments providing a complete assessment of 89 symptomatic hands. The mean Boston carpal tunnel questionnaire scores improved significantly from 2.45 to 2.12 and throughout the duration of the study 73% of patients improved with conservative treatment and 14% did not require surgery. Severity scoring at presentation was predictive of outcome with conservative therapy. This work suggests that the Boston carpal tunnel questionnaire can be used to identify patients who are likely to respond to conservative treatment. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate whether bilateral widespread pressure hypersensitivity exists in patients with unilateral carpal tunnel syndrome. A total of 20 females with carpal tunnel syndrome (aged 22–60 years), and 20 healthy matched females (aged 21–60 years old) were recruited. Pressure pain thresholds were assessed bilaterally over median, ulnar, and radial nerve trunks, the C5–C6 zygapophyseal joint, the carpal tunnel and the tibialis anterior muscle in a blinded design. The results showed that pressure pain threshold levels were significantly decreased bilaterally over the median, ulnar, and radial nerve trunks, the carpal tunnel, the C5–C6 zygapophyseal joint, and the tibialis anterior muscle in patients with unilateral carpal tunnel syndrome as compared to healthy controls (all, P < 0.001). Pressure pain threshold was negatively correlated to both hand pain intensity and duration of symptoms (all, P < 0.001). Our findings revealed bilateral widespread pressure hypersensitivity in subjects with carpal tunnel syndrome, which suggest that widespread central sensitization is involved in patients with unilateral carpal tunnel syndrome. The generalized decrease in pressure pain thresholds associated with pain intensity and duration of symptoms supports a role of the peripheral drive to initiate and maintain central sensitization. Nevertheless, both central and peripheral sensitization mechanisms are probably involved at the same time in carpal tunnel syndrome. [ABSTRACT FROM PUBLISHER]

The aim of the current study was to investigate the sensitivity and spesificity of Semmes- Weinstein monofilament test in diagnosis of carpal tunnel syndrome. Totally fifty patients and their eighty five hands were included in this study. Carpal tunnel syndrome was diagnosed as electroneuromyographic study in fifty five hands of thirty patients and it wasn't diagnosed at thirty hands of eighteen patients. The patients were evaluated by two different protocols of Semmes-Weinstein monofilament test that are used in diagnosis of carpal tunnel syndrome. At the end of the study, we found that sensitivity of Semmes-Weinstein monofilament test was %85,5 and spesificity was %10 according to first protocol, it's sensitivity was %43,6 and spesificity was %90 according to second protocol. In conclusion, we think that Semmes- Weinstein monofilament test is insufficient alone in diagnosis of carpal tunnel syndrome [ABSTRACT FROM AUTHOR]

The article presents a case study of a forty six year-old man with Klippel-Trénaunay syndrome and bilateral macrodactyly who presented to physicians with pain and numbness in the thumb and the index and long fingers of his right hand. A discussion of diagnostic testing which was performed on the man and resulted in a diagnosis of carpal tunnel syndrome that was caused by fibrolipomatous hamartoma of his median nerve is presented. His medical treatment and recovery are discussed.

Abstract: The availability of effective experimental models for investigating nerve regeneration and designing new strategies for promoting this unique repair process is important. The aim of this study was to standardize a rat median nerve crush injury model using a non-serrated clamp exerting a compression force of 17.02MPa for a duration of 30s. Results showed that functional recovery, evaluated by grasping test, was already detectable at day-12 and progressively increased until day-28 after which animal performance plateaued until the end of testing (day-42), reaching a range of 75–80% of pre-operative values. Morphological analysis on the median nerve segments, distal to the crush lesion, which were withdrawn at the end of the experiment showed that regenerated nerve fibers are significantly more numerous and densely packed; they are also smaller and have a thinner myelin sheath compared to controls. Together, these results provide a baseline characterization of the crush median nerve injury experimental model for its employment in the investigation of nerve regeneration research, especially when a reproducible regeneration process is required, such as for the study of biological mechanisms of peripheral nerve fiber regeneration or development of new therapeutic agents for promoting posttraumatic nerve repair. [Copyright &y& Elsevier]

Abstract: Introduction: Wounds on the palmar side of the wrist affecting the median or ulnar nerves are responsible for motor and sensory sequelae, severe pain and cold intolerance. Materials and methods: Thirty-nine patients with 40nerve sections were retrospectively reviewed with a mean follow up of 23months. The median nerve alone was affected 20times, the ulnar nerve seven times and both nerves simultaneously 13times. In 75% of the cases, there was an associated vascular injury (radial artery and/or ulnar artery). The average number of tendons cut was 4.25. Results: After repair of the median nerve, 71% of patients recovered antepulsion and opposition that was normal or possible against resistance. The strength was approximately 70% of the opposite side. The sensitive recovery was good (S3 in≥50% of cases) but it was accompanied by cold intolerance one out of two patients. After repair of the ulnar nerve, 29% of the cases had an ulnar claw hand, 71% of patients recovered sensitivity greater or equal to S3 but with cold intolerance in 42% of the cases. The combined median and ulnar sections had a poorer sensory-motor prognosis. Revision surgery was necessary in 12 of these cases. Conclusion: Sensory recovery after an isolated ulnar nerve lesion at the wrist is better than after an isolated median nerve lesion but there is no difference in the motor recovery. Combined median and ulnar lesions have an especially bad prognosis and may require secondary palliative surgery. The existence of nerve contusion and a high number of tendon injuries were factors associated with a poorer prognosis. [Copyright &y& Elsevier]

The article focuses on the contribution of James Paget to neurology. He was known for his research chronic inflammation of the bones known as Paget's disease of bone. He was cited to be the first to study the origins of the carpal tunnel syndrome with his description of median nerve compression resulting from a radial fracture.

The article discusses the randomized controlled intervention trial which was conducted to determine the effects of an alternative mouse and, or a forearm support board on nerve function at the wrist among engineers. Distal motor latency (DML) at baseline and follow-up was conducted for the median and ulnar nerves at the right wrist. The researchers assessed that in engineers who use a computer for more than 20 hour per week, an alternative mouse may have a protective effect of ulnar nerve function at the wrist.

Objective: In Turkey, the illiterate patients may not be able to complete many self-administered questionnaires. The aim of this study was to adapt the self-administered Boston questionnaire (BQ) for the assessment of the severity of symptoms and functional status (BQ-SS, BQ-F) in carpal tunnel syndrome to the illiterate Turkish population and investigate the reliability of the cross cultured adaptation. Material and Methods: A total of 120 outpatients with carpal tunnel syndrome (60 literate, 60 illiterate) were assessed using this Turkish version of BQ. Translation/back-translation of the English version BQ was done by using blinded method and independently by four different individuals, and adapted by a team. For illiterate people, the term "writing" was changed as "crocheting" and the statement "holding a book while reading" was modified as "holding the Holy Quran while reading". Reliability was investigated by the reproducibility and internal consistency. Results: Cronbach's alpha was calculated at 0.914 for BQ-SS scale, 0.94 for BQ-F scale in the illiterate group and at 0.971 for BQ-SS scale, 0.96 for BQ-F scale in the literate group, respectively. The intraclass correlation coefficients were excellent and range between 0.89 and 0.96 for BQ-SS and BQ-F in the illiterate and the literate patients. Conclusion: This adapted version of BQ provides a reliable tool in iliterate Turkish patients with carpal tunnel syndrome. For application of self-administered questionnaire, some conceptual modifications should be required for accommodation of the different educational levels. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Analyzing the literature and elaborating recommendations on the following topics: relevance of dorsal root entry zone (DREZ) lesions, surgical treatment for posttraumatic syringomyelia, other therapeutic approaches (peripheral nerve root pain, nerve trunk pain and Sign Posterior Cord [SCI] pain). Material and Methods: The methodology used, proposed by the French Society of Physical Medicine and Rehabilitation (SOFMER), includes a systematic review of the literature, the gathering of information regarding current clinical practices and a validation by a multidisciplinary panel of experts. Results: Ninety-two articles were selected, 10 with a level of evidence at 2, 82 with a level of evidence at 4. Some articles lacked information on the type of injury, the pain characteristics and the symptoms’ evolution over time. Drez: This type of procedure has been validated for its effectiveness on pain at the level of injury (transitional zone pain), but is inefficient for pain located below the level of injury. Posttraumatic syringomyelia (PTS): suspected when there is an increased neurological impairment, changes below the level of injury (mainly bladder dysfunctions) or a sudden onset of pain. The surgery associates arachnoid grafting, cyst drainage, expansile dural plasty (same treatment for posttraumatic tethered spinal cord and posttraumatic myelomalacia). Peripheral nerve root, nerve trunk or transitional zone pain: Surgical implants (screws or clips) can generate radicular pain caused by inflammation and they can even move around with time. The material-induced constraints can also trigger pain. Surgical removal of osteosynthesis material (with an eventual saddle block) remains a simple procedure yielding good results. Correcting surgeries can also be performed (malunion and nonunion). Finally, compressive neuropathies (carpal tunnel syndrome, ulnar nerve entrapment) already have a well-defined treatment. Conclusion: The literature review can define the relevance of surgical treatments on some types of SCI pain. However, the results of many articles are difficult to analyze, as they do not report clinical or follow-up data. [Copyright &y& Elsevier]

The carpal tunnel syndrome - compression of the median nerve by the transverse ligament of the wrist - is a serious disease of the human hand. The electrophysiological changes in the median nerve can be easily followed by electroneurography (ENG). The degenerative changes in the collagen structures of the carpal ligament cause shrinking of the ligament and compression of the nerve. According to the present study we could demonstrate that DSC is a useful and well applicable method for the investigation of collagen tissue of the human carpal transverse ligament. DSC scans clearly demonstrated significant differences between the different types and conditions of samples (control: Tm=61.3°C and Δ Hcal=4.04 J g−1, mild: Tm=62°C and Δ Hcal=4.3 J g−1, middle: Tm=61.5°C and ΔHcal=5.17 J g−1 as well as severe: Tm=61.85°C and Δ Hcal=8.44 J g−1). After these investigations we can choose the optimal time of surgical therapy of different clinical level carpal tunnel syndrome too. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The aim of this study was to evaluate the function of Aδ fibers at the hand level in patients with clinical symptoms of Carpal Tunnel Syndrome (CTS) using CO2 laser evoked potentials (LEPs), in light of the intensity and distribution of sensory symptoms and pain. Methods: Thirty-four CTS outpatients (62 hands) were compared to 23 sex- and age-matched control subjects (46 hands). The periungueal skin of the first, second, third and fifth fingers, and the dorsum of the hands were stimulated in random order. The latency and amplitude of the N2, P2 and N1 components were evaluated with respect to the Nerve Conduction Study (NCS) data, clinical scales, pain intensity and glove-like symptoms distribution. Results: The amplitude of the N2–P2 complex was significantly reduced in CTS hands compared to normal hands after stimulation of the second and third fingers, even in patients with mild nerve conduction impairment. No significant fifth finger LEP abnormalities were found in patients with glove-like distribution symptoms. The N2–P2 amplitude at the second and third fingers was positively correlated with the severity of sensory symptoms. Conclusions: The involvement of median nerve Aδ fibers in CTS seems to be an early phenomenon, which concurs with the impairment of large motor and sensory afferents and is linked to the severity of the disease. Significance: The finding of reduced sensory symptoms in patients with severe thin afferents damage, may suggest a slight expression of central sensitisation phenomena in the advanced stage of CTS syndrome. [Copyright &y& Elsevier]

Background: Carpal tunnel syndrome (CTS) is a socially and economically relevant disease caused by compression or entrapment of the median nerve within the carpal tunnel. This population-based case-control study aims to investigate occupational/non-occupational risk factors for surgically treated CTS. Methods: Cases (n = 220) aged 18-65 years were randomly drawn from 13 administrative databases of citizens who were surgically treated with carpal tunnel release during 2001. Controls (n = 356) were randomly sampled from National Health Service registry records and were frequency matched by age-gender-specific CTS hospitalization rates. Results: At multivariate analysis, risk factors were blue-collar/housewife status, BMI ≥ 30 kg/m², sibling history of CTS and coexistence of trigger finger. Being relatively tall (cut-offs based on tertiles: women ≥165 cm; men ≥175 cm) was associated with lower risk. Blue-collar work was a moderate/strong risk factor in both sexes. Raised risks were apparent for combinations of biomechanical risk factors that included frequent repetitivity and sustained force. Conclusion: This study strongly underlines the relevance of biomechanical exposures in both nonindustrial and industrial work as risk factors for surgically treated CTS. [ABSTRACT FROM AUTHOR]

Purpose: Posttraumatic cold intolerance (CI) is a frequent and important sequel after peripheral nerve injury. In this study, it is hypothesized that altered rewarming patterns after peripheral nerve injury are related to the degree of posttraumatic CI. This hypothesis is tested by quantitatively comparing rewarming patterns of the digits in controls and in median or ulnar nerve injury patients and by investigating relationships between rewarming patterns, sensory recovery, and CI. Methods: Twelve median or ulnar nerve injury patients with a follow-up of 4 to 76 months after nerve repair and 13 control subjects had isolated cold stress testing of the hands. Video thermography was used to analyze and compare rewarming patterns of the injured and uninjured digits after cold stress testing. Temperature curves were analyzed by calculating the Q value as an indicator of heat transfer (temperature added during the first 10 minutes after start of active rewarming) and the maximum slope. Results: Test–retest reliability was 0.64 and 0.79, respectively, for the Q value and maximum slope. High Q values and maximum slopes were interpreted as the presence of active rewarming. Patients with return of active rewarming had better sensory recovery and lower Blond McIndoe Cold Intolerance Severity Scale (CISS) scores. Better sensory recovery was correlated with lower CISS scores. Conclusions: Test–retest reliability of cold stress testing was good, and we found a difference in rewarming patterns between nerve injury patients and controls. The presence of active rewarming in the nerve injury patients was related to sensory recovery and fewer complaints of posttraumatic CI. [Copyright &y& Elsevier]

Purpose: The objective of this study was to measure the relative motion of the middle finger flexor digitorum superficialis (FDS) tendon, its adjacent subsynovial connective tissue (SSCT), and the median nerve during single-digit motion within the carpal tunnel in human cadaver specimens and to estimate the relative motions of these structures in different wrist positions. Methods: Using fluoroscopy during simulated single-digit flexion, we measured the relative motion of the middle finger FDS tendon, SSCT, and median nerve within the carpal tunnel in 12 human cadavers. Measurements were obtained for 3 wrist positions: neutral, 60° flexion, and 60° extension. After testing with an intact carpal tunnel was completed, the flexor retinaculum was cut with a scalpel, and the same testing procedure was repeated for each wrist position. The relative motions of the tendon, SSCT, and median nerve were compared using a shear index, defined as the ratio of the difference in motion along the direction of tendon excursion between 2 tissues divided by tendon excursion, expressed as a percentage. Results: Both tendon–SSCT and tendon–nerve shear index were significantly higher in the 60° of wrist flexion and extension positions than in the neutral position. After division of the flexor retinaculum, the shear index in the 60° wrist extension position remained significantly different from that of the neutral position. Conclusions: We have found that the relative motion between a tendon and SSCT in the carpal tunnel is maximal at extremes of wrist motion. These positions may predispose the SSCT to shear injury. [Copyright &y& Elsevier]

The article presents a systematic review on the exposure-response relationships between work-related factors and the carpal tunnel syndrome (CTS). It notes that CTS is the most frequently reported neuropathy of the upper extremity which often caused by the compromise of the median nerve at the wrist due to increase pressure in the carpal tunnel. Accordingly, the review provides indications that CTS is linked with an average hand force requirement and repetitiveness of work.

Objective: To demonstrate the efficiency of complex rehabilitation treatment for carpal tunnel syndrome. Material and method: There were selected 30 patients with carpal tunnel syndrome with moderate severity. We used Boston questionnaire for the assessment of severity of symptoms and functional status and sonographic exam. Sonographic examination of carpal tunnel was directed towards median nerve CSA (cross-sectional area) measurement. For patients with moderate symptoms we found a CSA between 11.8 and 14.3 mm². Patients were randomly divided in two groups. All patients received NSAID and local applications of therapeutic laser and therapeutic ultrasound (three times a week for four weeks) Patients from group B received also a wrist-hand orthosis with wrist joint and MCP joints in neutral (to be worn at night time for 4 weeks). Clinical and sonographic assessment was done at the beginning of the study and at the end of the treatment. Results: Complex rehabilitation treatment (therapeutic laser, therapeutic ultrasound and wrist-hand orthosis) proved to be efficient in symptoms control. Comparing the results from group A and group B we found that the improvement was significant for patients from group B. Pain control was not significant for patients from group A. Conclusions: Conservative treatment in carpal tunnel syndrome proved to be effective when local treatment is associated with nocturnal wearing of a wrist-hand orthosis. Additional studies are requested to evaluate long term impact of conservative treatment. [ABSTRACT FROM AUTHOR]

Abstract: Standard electrophysiological techniques and analysis of the stimulus–response relationship (i.e., the input–output (I–O) curves) of the median nerve were performed in 16 patients with carpal tunnel syndrome (CTS) both prior to and 1 and 6 months after surgical decompression at the wrist. One month after carpal tunnel release (CTR), conduction in cutaneous and motor axons (i.e., sensory conduction velocity and distal motor latency) was found to be improved with respect to pre-surgical values, whereas motor action potentials and the motor I–O curve showed a decrease with respect to control values. This suggested reduced efficiency of axon recruitment following CTR. Six months after surgery, all parameters were significantly improved with respect to control values. The sensory and motor I–O curves suggested that the reduced motor fibre recruitment efficiency observed 1 month after CTR was due to changes in current density distributions under the surface stimulating electrode on the median nerve at the wrist. Slight transient compression (such as that due to post-surgical oedema) acting on median fibres located superficially within the nerve cannot be excluded, however. Since electrophysiological studies are an important, objective method of evaluating the outcome of surgical CTR, electrophysiologists must be aware of the possibility of reduced compound motor action potential (CMAP) in the first few months after surgery. [Copyright &y& Elsevier]

Background: There is no clear-cut consensus on the best diagnostic criteria for carpal tunnel syndrome. The objective of this study was to compare the probability of carpal tunnel syndrome being present following electrodiagnostic testing with the probability of it being present after the diagnosis was established on the basis of a clinical evaluation alone. Methods: The study sample included patients with any peripheral nerve diagnosis who had been referred to the electrodiagnostic laboratory of an academic health-care center. The probability of carpal tunnel syndrome before electrodiagnostic testing (pretest probability) was estimated with use of the CTS-6, a validated clinical diagnostic aid that is used to estimate the probability of carpal tunnel syndrome on the basis of the presence or absence of six clinical findings recorded as part of the history or noted on physical examination. All patients then underwent a standard electrodiagnostic assessment of the median nerve by a neurologist blinded to the result of the CTS-6 evaluation. Sensory nerve conduction velocity was used to classify the result of the electrodiagnostic testing as either positive or negative for carpal tunnel syndrome with use of two different criteria (one stringent and one lax) derived from the literature. The main outcome measure was the difference between the pretest and posttest probabilities of carpal tunnel syndrome. Results: One hundred and forty-three patients were studied. The pretest probability of carpal tunnel syndrome ranged between 0.10 and 0.99 (mean [and standard deviation], 0.81 ± 0.22). Seventy-three percent of the patients had a pretest probability of at least 0.80. The average change in probability for these patients was -0.02 when the stringent electrodiagnostic criterion was used and -0.06 when the lax criterion was used. With either electrodiagnostic criterion, the majority of the large changes in probability were for patients for whom the pretest probability was ≤0.50. The probability of carpal tunnel syndrome was lowered after the electrodiagnostic testing in most of these cases. Conclusions: For the majority of patients who are considered to have carpal tunnel syndrome on the basis of their history and physical examination alone, electrodiagnostic tests do not change the probability of diagnosing this condition to an extent that is clinically relevant. Level of Evidence: Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

The article presents a study which investigates the risk factors for Carpal tunnel syndrome (CTS) and median neuropathy in a working population. It states that CTS was defined by median neuropathy and associated symptoms. It discusses the findings of the study which demonstrate that 18 workers had CTS and 131 had evidenced of median neuropathy both personal and work-related risk factors. It notes that the work-related exposures were estimated by two methods, including self-report and job title based ratings. It concludes that both work and personal factors mediated median nerve impairment. Moreover, it mentions that construction workers are at an increased risk of CTS so awareness should be raised and interventions should specifically target the risk group.

Summary: Background: Patients in a minimally conscious state (MCS) show restricted self or environment awareness but are unable to communicate consistently and reliably. Therefore, better understanding of cerebral noxious processing in these patients is of clinical, therapeutic, and ethical relevance. Methods: We studied brain activation induced by bilateral electrical stimulation of the median nerve in five patients in MCS (aged 18–74 years) compared with 15 controls (19–64 years) and 15 patients (19–75 years) in a persistent vegetative state (PVS) with 15O-radiolabelled water PET. By way of psychophysiological interaction analysis, we also investigated the functional connectivity of the primary somatosensory cortex (S1) in patients and controls. Patients in MCS were scanned 57 (SD 33) days after admission, and patients in PVS 36 (9) days after admission. Stimulation intensities were 8·6 (SD 6·7) mA in patients in MCS, 7·4 (5·9) mA in controls, and 14·2 (8·7) mA in patients in PVS. Significant results were thresholded at p values of less than 0·05 and corrected for multiple comparisons. Findings: In patients in MCS and in controls, noxious stimulation activated the thalamus, S1, and the secondary somatosensory or insular, frontoparietal, and anterior cingulate cortices (known as the pain matrix). No area was less activated in the patients in MCS than in the controls. All areas of the cortical pain matrix showed greater activation in patients in MCS than in those in PVS. Finally, in contrast with patients in PVS, those in MCS had preserved functional connectivity between S1 and a widespread cortical network that includes the frontoparietal associative cortices. Interpretation: Cerebral correlates of pain processing are found in a similar network in controls and patients in MCS but are much more widespread than in patients in PVS. These findings might be objective evidence of a potential pain perception capacity in patients in MCS, which supports the idea that these patients need analgesic treatment. Funding: FNRS; Reine Elisabeth Medical Foundation; University of Liège; European Commission; James S McDonnell Foundation; Mind Science Foundation; Concerted Research Action; Fondation Léon Frédéricq. [Copyright &y& Elsevier]